Latency after Preterm Prelabor Rupture of the Membranes: Increased Risk for Periventricular Leukomalacia
Objective. To identify the risk factors for cystic periventricular leukomalacia (cPVL) and their implications for deciding between immediate delivery and conservative management of preterm prelabor rupture of the membranes (pPROM). Methods. The following risk factors were compared between cPVL infan...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Journal of Pregnancy |
| Online Access: | http://dx.doi.org/10.1155/2014/874984 |
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| author | Annick Denzler Tilo Burkhardt Giancarlo Natalucci Roland Zimmermann |
| author_facet | Annick Denzler Tilo Burkhardt Giancarlo Natalucci Roland Zimmermann |
| author_sort | Annick Denzler |
| collection | DOAJ |
| description | Objective. To identify the risk factors for cystic periventricular leukomalacia (cPVL) and their implications for deciding between immediate delivery and conservative management of preterm prelabor rupture of the membranes (pPROM). Methods. The following risk factors were compared between cPVL infants and 6440 controls: chorioamnionitis, sex, gestational age (GA), birth weight, pPROM, and pPROM-delivery interval. Factor impact on cPVL risk and clinical decision-making was determined by multivariate logistic regression. Results. Overall cPVL prevalence (n=32) was 0.99/1000 births. All cPVL infants but one were born <34 weeks of gestation and were <2500 g; 56% had histological chorioamnionitis versus 1.1% of controls (OR 35.9; 95%-CI 12.6–102.7). Because chorioamnionitis is a postnatal diagnosis, logistic regression was performed with prenatally available factors: pPROM-delivery interval >48 hours (OR 9.0; 95%-CI 4.1–20.0), male gender (OR 3.2; 95%-CI 1.4–7.3). GA was not a risk factor if birth weight was included. Risk decreased with increasing fetal weight despite a prolonged pPROM-delivery interval. Conclusion. pPROM-delivery interval is the single most important prenatally available risk factor for the development of cPVL. Immediate delivery favors babies with chorioamnionitis but disfavors those with non infectious pPROM. In the absence of clinical chorioamnionitis fetal weight gain may offset the inflammatory risk of cPVL caused by a prolonged pPROM-delivery interval. |
| format | Article |
| id | doaj-art-ed2ba964894e4cccb752b013765ad400 |
| institution | OA Journals |
| issn | 2090-2727 2090-2735 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Pregnancy |
| spelling | doaj-art-ed2ba964894e4cccb752b013765ad4002025-08-20T02:22:06ZengWileyJournal of Pregnancy2090-27272090-27352014-01-01201410.1155/2014/874984874984Latency after Preterm Prelabor Rupture of the Membranes: Increased Risk for Periventricular LeukomalaciaAnnick Denzler0Tilo Burkhardt1Giancarlo Natalucci2Roland Zimmermann3Department of Obstetrics, Zurich University Hospital, Frauenklinikstraße 10, 8091 Zurich, SwitzerlandDepartment of Obstetrics, Zurich University Hospital, Frauenklinikstraße 10, 8091 Zurich, SwitzerlandDepartment of Neonatology, Zurich University Hospital, Frauenklinikstraße 10, 8091 Zurich, SwitzerlandDepartment of Obstetrics, Zurich University Hospital, Frauenklinikstraße 10, 8091 Zurich, SwitzerlandObjective. To identify the risk factors for cystic periventricular leukomalacia (cPVL) and their implications for deciding between immediate delivery and conservative management of preterm prelabor rupture of the membranes (pPROM). Methods. The following risk factors were compared between cPVL infants and 6440 controls: chorioamnionitis, sex, gestational age (GA), birth weight, pPROM, and pPROM-delivery interval. Factor impact on cPVL risk and clinical decision-making was determined by multivariate logistic regression. Results. Overall cPVL prevalence (n=32) was 0.99/1000 births. All cPVL infants but one were born <34 weeks of gestation and were <2500 g; 56% had histological chorioamnionitis versus 1.1% of controls (OR 35.9; 95%-CI 12.6–102.7). Because chorioamnionitis is a postnatal diagnosis, logistic regression was performed with prenatally available factors: pPROM-delivery interval >48 hours (OR 9.0; 95%-CI 4.1–20.0), male gender (OR 3.2; 95%-CI 1.4–7.3). GA was not a risk factor if birth weight was included. Risk decreased with increasing fetal weight despite a prolonged pPROM-delivery interval. Conclusion. pPROM-delivery interval is the single most important prenatally available risk factor for the development of cPVL. Immediate delivery favors babies with chorioamnionitis but disfavors those with non infectious pPROM. In the absence of clinical chorioamnionitis fetal weight gain may offset the inflammatory risk of cPVL caused by a prolonged pPROM-delivery interval.http://dx.doi.org/10.1155/2014/874984 |
| spellingShingle | Annick Denzler Tilo Burkhardt Giancarlo Natalucci Roland Zimmermann Latency after Preterm Prelabor Rupture of the Membranes: Increased Risk for Periventricular Leukomalacia Journal of Pregnancy |
| title | Latency after Preterm Prelabor Rupture of the Membranes: Increased Risk for Periventricular Leukomalacia |
| title_full | Latency after Preterm Prelabor Rupture of the Membranes: Increased Risk for Periventricular Leukomalacia |
| title_fullStr | Latency after Preterm Prelabor Rupture of the Membranes: Increased Risk for Periventricular Leukomalacia |
| title_full_unstemmed | Latency after Preterm Prelabor Rupture of the Membranes: Increased Risk for Periventricular Leukomalacia |
| title_short | Latency after Preterm Prelabor Rupture of the Membranes: Increased Risk for Periventricular Leukomalacia |
| title_sort | latency after preterm prelabor rupture of the membranes increased risk for periventricular leukomalacia |
| url | http://dx.doi.org/10.1155/2014/874984 |
| work_keys_str_mv | AT annickdenzler latencyafterpretermprelaborruptureofthemembranesincreasedriskforperiventricularleukomalacia AT tiloburkhardt latencyafterpretermprelaborruptureofthemembranesincreasedriskforperiventricularleukomalacia AT giancarlonatalucci latencyafterpretermprelaborruptureofthemembranesincreasedriskforperiventricularleukomalacia AT rolandzimmermann latencyafterpretermprelaborruptureofthemembranesincreasedriskforperiventricularleukomalacia |